implementation and evaluation of revised protocols for oral hygiene for mechanically ventilated patients

Conditions: Ventilator Associated Pneumonia; Oral Hygiene

Summary: the primary objective of this study is to evaluate the effectiveness and feasibility of the implementation of revised standards of care for oral hygiene (sage q-care q2 oral cleansing and suctioning system with and without chlorhexidine gluconate) relative to the current routine standard of care in mechanically ventilated patients admitted to the adult intensive care units in alberta health services calgary zone. this pilot study will evaluate the feasibility of performing a larger definitive study. the primary assessment of effectiveness for the definitive study will be the proportion of patients who develop ventilator-associated pneumonia.

the primary objective of this study is to evaluate the effectiveness and feasibility of the implementation of revised standards of care for oral hygiene (sage q-care q2 oral cleansing and suctioning system with and without chlorhexidine gluconate) relative to the current routine standard of care in mechanically ventilated patients admitted to the adult intensive care units in alberta health services calgary zone. this pilot study will evaluate the feasibility of performing a larger definitive study. the primary assessment of effectiveness for the definitive study will be the proportion of patients who develop ventilator-associated pneumonia. 150 subjects will be randomly assigned using sealed opaque envelopes to one of three groups (oral hygiene provided via the current local standard of care; oral hygiene provided with a commercial packaged product (sage q-care q2 oral cleansing and suctioning system); oral hygiene provided with a similar commercial packaged product with added chlorhexidine rinses twice daily (sage 24-hour suction systems with chlorhexidine gluconate). subjects will be provided the assigned method of oral hygiene by the bedside nurses from the time of icu admission to the time of icu discharge. key measurements include the acquisition of ventilator-associated pneumonia; the documented frequency of provision of oral care; the state of oral hygiene evaluated by recorded oral hygiene scores; duration of mechanical ventilation; icu and hospital lengths of stay; icu and hospital survival; antimicrobial utilization; and the acquisition of antimicrobial resistant microbes. for comparison of outcomes, means (with standard deviations) and medians (with interquartile ranges) will be reported for normally distributed and skewed variables respectively, and will be compared among the three groups using anova or kruskal-wallis tests, respectively. only the first episode of vap in a patient will be evaluated. given the small size of this pilot study, no interim or subgroup analyses are planned.

Eligibility criteria:
inclusion criteria: * adults (at least 18 years old) * newly admitted to the intensive care unit * receiving invasive mechanical ventilation via a endotracheal tube or tracheostomy exclusion criteria: * under the age of 18 * documented allergy to chlorhexidine * contraindication to the provision of standard oral hygiene (eg. recent oropharyngeal surgery or a defined surgical limitation to oral care)

Keywords: oral care oral hygiene intensive care mechanical ventilation chlorhexidine